Monday, August 28, 2017

ADHD Symptoms May Lead Adolescent Girls to Start Smoking Early

Adolescents with more severe symptoms of attention-deficit/hyperactivity disorder (ADHD)—particularly high levels of inattention—may be more likely to start smoking cigarettes before they reach 18, according to a study published Friday in AJP in Advance. This risk of smoking was especially apparent for adolescent girls with ADHD.

“This study confirms that specific relationships between inattention and smoking observed in previous research may arise partially from causal effects, which has implications for intervention,” wrote Irene Elkins, Ph.D., of the University of Minnesota and colleagues. “Preventing nicotine exposure among females with ADHD is critical, as adolescent females may be more susceptible to nicotine’s neurotoxic effects.”

Elkins and colleagues analyzed data from three study cohorts of same-sex twins that included 3,762 individuals (52% female). They found that regardless of gender, adolescents with high inattentive symptoms were more likely to start smoking (and to do so earlier). However, unlike with adolescent boys, these symptoms were also associated with a faster progression to daily smoking, more cigarettes smoked per day, and more symptoms of nicotine dependence.

Further, within identical twin pairs of girls, the twin with greater inattention problems was significantly more likely to smoke more, smoke daily, and develop nicotine dependence. This finding points to a possible causal influence of inattention on smoking, as identical twins have similar genetic and familial traits. This difference between identical twin pairs was not seen in boys.

Elkins and colleagues noted that the evidence of causality bolsters the idea that teenage girls with ADHD use nicotine to self-medicate their attention problems, but cautioned that even if inattention is causal, other factors may be involved. “The increased vulnerability of females to peer and academic consequences of inattention may contribute to greater depression and anxiety among inattentive females relative to inattentive males, increasing their receptivity to nicotine’s effects on attention and mood.”

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